Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
PLoS One. 2023 Aug 7;18(8):e0289655. doi: 10.1371/journal.pone.0289655. eCollection 2023.
The aim of the study was to ascertain risk factors and outcomes of elective cesarean deliveries performed urgently prior to their scheduled date.
Women carrying a viable singleton fetus who were scheduled for elective cesarean delivery at a tertiary medical center between 2012-2020 were identified by retrospective database. Differences in maternal and neonatal parameters between those who ultimately required urgent cesarean delivery and those who underwent the procedure as scheduled were analyzed.
Of 4403 women who met the inclusion criteria, 559 underwent urgent cesarean delivery before the scheduled date. On multivariate analysis, factors significantly associated with a risk of transformation to an urgent cesarean delivery were chronic hypertension (aOR 1.92, 95% CI 1.30-2.83 P = 0.001), antenatal corticosteroids administration (aOR 3.26, 95% CI 2.38-4.47, P <0.001), and contraindication for vaginal delivery as the reason for elective cesarean delivery (aOR 1.67, 95% CI 1.32-2.12, P <0.001). Neonates born via urgent cesareans had an increased risk of 1-minute Apgar <7 (6% vs. 1.7%, P <0.001), intensive care unit admission (6.6% vs. 2.5%, P <0.001); their mothers were at risk of postpartum hemorrhage (5.9% vs. 3%, P = 0.001).
The present study sheds light on the risk factors and maternal and fetal morbidities associated with elective cesarean deliveries that become urgent before the originally scheduled date. Physicians should take this information into account when planning an optimal date for elective cesarean delivery.
本研究旨在确定在预定日期前紧急进行择期剖宫产的风险因素和结局。
通过回顾性数据库，确定了 2012 年至 2020 年期间在三级医疗中心行择期剖宫产的活胎单胎孕妇。分析了最终需要紧急剖宫产和按计划进行手术的产妇和新生儿参数的差异。
在符合纳入标准的 4403 名妇女中，有 559 名妇女在预定日期前进行了紧急剖宫产。多变量分析显示，与紧急剖宫产风险相关的因素有慢性高血压（aOR 1.92，95%CI 1.30-2.83，P=0.001）、产前皮质激素的应用（aOR 3.26，95%CI 2.38-4.47，P<0.001）和择期剖宫产的阴道分娩禁忌证（aOR 1.67，95%CI 1.32-2.12，P<0.001）。紧急剖宫产分娩的新生儿发生 1 分钟 Apgar 评分<7 的风险增加（6% vs. 1.7%，P<0.001）、入住重症监护病房（6.6% vs. 2.5%，P<0.001）；母亲有发生产后出血的风险（5.9% vs. 3%，P=0.001）。
本研究揭示了与预定日期前紧急进行择期剖宫产相关的风险因素以及母婴发病率。医生在计划择期剖宫产的最佳日期时应考虑这些信息。
